Method and apparatus for stitching tendons

ABSTRACT

Methods and apparatuses for repairing a tear in soft tissue are disclosed. A method according to the principles of the present disclosure includes connecting an intermediate member to a bone anchor and placing the intermediate member on the soft tissue. The method further includes inserting a first suture through the intermediate member and the soft tissue to attach the intermediate member to the soft tissue and fixing the bone anchor to bone to secure the soft tissue to the bone.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of: (1.) U.S. patentapplication Ser. No. 13/288,459 filed on Nov. 3, 2011, and (2.) U.S.patent application Ser. No. 13/288,463 filed on Nov. 3, 2011. The entiredisclosures of each of the above applications are incorporated herein byreference.

FIELD

The present disclosure relates to methods and apparatuses for stitchingtendons.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

Tears caused by trauma or disease in soft tissue, such as cartilage,ligament, or muscle, can be repaired by suturing. A suture construct maybe used to secure the soft tissue to bone. One end of the sutureconstruct may be secured to the soft tissue using stitches, and theother end of the suture construct may be secured to the bone using ananchor. The suture construct may include an adjustable loop includingstrands that may be pulled to reduce the size of the adjustable loop andthereby bring the soft tissue closer to bone.

Occasionally, the stitches securing the suture construct to the softtissue may pull through the tissue. In particular, the stitch closest tothe end of the tissue tear, adjacent to the anchor, may pull through thetissue, resulting in considerable movement of the soft tissue withrespect to its original location in or on the bone. Thus, there is aneed in the relevant art for tissue repair techniques and associateddevices for facilitating suturing and stitching while preventingstitches from pulling through tissue.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

Methods and apparatuses for repairing a tear in soft tissue aredisclosed. A method according to the principles of the presentdisclosure includes connecting an intermediate member to a bone anchorand placing the intermediate member on the soft tissue. The methodfurther includes inserting a first suture through the intermediatemember and the soft tissue to attach the intermediate member to the softtissue and fixing the bone anchor to bone to secure the soft tissue tothe bone.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is a perspective view of a first example of an intermediatemember routed through a flexible anchor and placed on one side of softtissue, with stiches extending through the intermediate member and intothe soft tissue;

FIG. 2 is a side view of the intermediate member and soft tissueconnected to the flexible anchor using a suture construct including anadjustable loop;

FIG. 3 is a top view of the intermediate member, soft tissue, flexibleanchor, and suture construct of FIG. 2;

FIG. 4 is a side view of the intermediate member, soft tissue, flexibleanchor, and suture construct of FIG. 2, with the intermediate memberplaced around the soft tissue and secured to the soft tissue usingstiches;

FIG. 5 is a side view similar to that shown in FIG. 4 but with theintermediate member secured to the soft tissue using flexible anchorsarranged in an inline configuration;

FIG. 6 is a side view similar to that shown in FIG. 4 but with theintermediate member secured to the soft tissue using flexible anchorsarranged in a u-shaped configuration;

FIGS. 7A and 7B are perspective views of adjustable loops extendingthrough soft tissue and a second example of an intermediate member, withlocking members inserted through the adjustable loops;

FIGS. 8 and 9 are perspective views of a third example of anintermediate member connected to a flexible anchor using an adjustableloop, the intermediate member including needles for additional fixationto soft tissue;

FIG. 10 is a perspective view of a fourth example of an intermediatemember connected to a flexible anchor using an adjustable loop, withstiches extending through the intermediate member and into soft tissue;

FIGS. 11 and 12 are perspective views of a fifth example of anintermediate member including an adjustable loop that is routed througha flexible anchor to secure the soft tissue to the flexible anchor; and

FIGS. 13A and 13B are side views of the intermediate member, softtissue, flexible anchor, and suture construct of FIGS. 11 and 12, withthe flexible anchor inserted into bone to secure the soft tissue to thebone.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

Referring to FIG. 1, an intermediate or load-dispersing member 10 isshown routed through a flexible anchor 12, with stiches 14 extendingthrough the intermediate member 10 and into soft tissue 16 to secure theintermediate member 10 to the soft tissue 16. The arrangement shown inFIG. 1 may be used to repair a tear in the soft tissue 16 such as byattaching the soft tissue 16 to another piece of soft tissue or to bone.Instead of applying tension directly to the stitches 14 when attachingthe soft tissue 16 to another piece of soft tissue or to bone, tensionmay be applied to the intermediate member 10, which in turn appliestension to the stiches 14. The intermediate member 10 aids in thedistribution of load on the stitches 14 to increase the stiffness andmaximum failure strength of the repair. In this regard, the intermediatemember 10 is configured to increase pull-out forces of the stitches 14and transfer load from those of the stitches 14 disposed closest to theflexible anchor 12 to those of the stitches 14 disposed further awayfrom the flexible anchor 12. The intermediate member 10 may be foldedover to form first and second segments 18, 20, both of which may beplaced on one side of the soft tissue 16.

The intermediate member 10 may be a flat, planar ribbon or sheath havinga width that is greater than its thickness. The intermediate member 10may be sufficiently strong to prevent the stitches 14 from being pulledtherethrough without tearing the intermediate member 10 but flexibleenough to enable manipulation thereof. The intermediate member 10 may bemade from polyester, polyethylene, polyurethane urea, and/orbioresorbable material. The intermediate member 10 may be braided, knit,or woven and/or may include a mesh or matrix such as a SportMesh™ SoftTissue Reinforcement, available from Arthrotek®, a Biomet® company ofWarsaw. Ind.

The flexible anchor 12 defines a passage 22 through which theintermediate member 10 is routed. The flexible anchor 12 may be insertedinto a hole drilled into bone, and tension may be applied to first andsecond segments 18, 20 of the intermediate member to set the flexibleanchor 12. In turn, the flexible anchor 12 engages the portion of thebone surrounding the hole and thereby secures the soft tissue 16 to thebone. The flexible anchor 12 may be a JuggerKnot™ Soft Anchor, availablefrom Biomet® of Warsaw, Ind. Further examples of flexible anchors aredisclosed in U.S. Patent Application Publication No. 2011/0264141, filedon Jul. 6, 2011, which is incorporated by reference herein in itsentirety.

Referring to FIGS. 2 and 3, the intermediate member 10 is shownconnected to the flexible anchor 12 using a preformed adjustableself-locking suture construct 24 that includes a tensioning member 26such as a double-loop configuration having two adjustable loops 28, 30.The tensioning member 26 may incorporate Ziploop™ Technology, availablefrom Biomet of Warsaw, Indiana. The tensioning member 26 includes asuture 32 having a first end 34 and a second end 36. The suture 32includes a braided body 38 having a first end 40 and a second end 42 anddefining a passage 44 therein.

To form the suture construct 24, the first end 34 of the suture 32 canbe inserted through the passage 22 in the flexible anchor 12 to positionthe first and second ends 40, 42 of the braided body 38 on oppositesides of the passage 22 as shown. The first end 34 of the suture 32 canthen be inserted through the first end 40 of the braided body 38,through the passage 44 in the braided body 38, and out the second end 42of the braided body 38 to form the adjustable loop 28. The second end 36of the suture 32 can then be inserted through the second end 42 of thebraided body 38, through the passage 44 in the braided body 38, and outthe first end 40 of the braided body 38 to form the adjustable loop 30.The first and second ends 34, 36 can then be tied together to form aknot 46 as shown or left as separate strands. The flexible anchor 12 andthe suture construct 24 can be provided together with the sutureconstruct 24 formed as shown.

To secure the soft tissue 16 to bone, the intermediate member 10 can beinserted partially through the adjustable loops 28, 30, folded, andplaced on one side of the soft tissue 16 to form a loop 48. The stitches14 can then be formed through the intermediate member 10 and the softtissue 16 to fix the intermediate member 10 to the soft tissue 16. Theflexible anchor 12 can then be fixed within the bone, and the first andsecond ends 34, 36 of the suture 32 can be pulled to decrease the sizeof the adjustable loops 28, 30. As the size of the adjustable loops 28,30 decreases, the soft tissue 16 is pulled closer to the location wherethe flexible anchor 12 is fixed to the bone.

In various implementations, the suture construct 24 may include multipleadjustable loops and/or multiple braided bodies arranged in variousconfigurations. Further examples of suture constructs are disclosed inU.S. Pat. No. 7.601,165, filed on Sep. 29, 2006, and U.S. Pat. No.7,959,650, filed on Aug. 22, 2008, which are incorporated by referenceherein in their entirety. Further examples of suture constructsincorporating flexible anchors are disclosed in U.S. Pat. No. 7,905,904,filed on Jan. 15, 2008, and U.S. Patent Application Publication No.201110098727 (“the '727 publication”), filed on Oct. 29, 2010, which areincorporated by reference herein in their entirety. An exemplaryembodiment of a preformed adjustable self-locking suture constructincluding a double-loop configuration is disclosed in FIG. 14 of the'727 publication, although other embodiments of the '727 publication maybe employed.

Referring to FIG. 4, the first and second segments 18, 20 of theintermediate member 10 are shown placed on opposite sides of the softtissue 16 and secured to the soft tissue 16 using stiches 50. To formeach of the stiches 50, a suture 52 may be passed through the firstsegment 18, the soft tissue 16, and the second segment 20 in onedirection. The suture 52 may then be passed back through the firstsegment 18, the soft tissue 16, and the second segment 20 in theopposite direction to form a loop 54. Opposite ends of the suture 52 maythen be tied together to form a knot 56.

Referring to FIG. 5, the intermediate member 10 is shown wrapped aroundthe soft tissue 16 with the first and second segments 18, 20 placed onopposite sides of the soft tissue 16 and secured to the soft tissue 16using preformed adjustable self-locking suture constructs 58 arranged inan inline configuration. Each of the suture constructs 58 includesflexible anchors 60, 62 positioned on opposite sides of the soft tissue16 and held together using a tensioning member 64. Each of thetensioning members 64 can include a suture 65 arranged in a double-loopconfiguration with two adjustable loops 66, 67 and ends 68. Thetensioning members 64 may incorporate Ziploop™ Technology, availablefrom Biomet of Warsaw, Ind.

Each of the suture constructs 58 may be preformed by passing the ends 68of the suture 65 through passages in the flexible anchors 60, 62 in amanner similar to that described above with respect to the sutureconstruct 24. One of the flexible anchors 60, 62 may then be pushedthrough the soft tissue 16 to position the flexible anchors 60, 62 onopposite sides of the soft tissue 16. The ends 68 of the suture 65 maythen be pulled to decrease the size of the adjustable loops 66, 67 andthereby bring the first and second segments 18, 20 of the intermediatemember 10 closer to each other. The ends 68 of the suture 65 may then betied together as shown or left as separate strands. An exemplary sutureconstruct including a double-loop configuration passed through twoflexible anchors is disclosed in FIG. 14 of the '727 publication.

Referring to FIG. 6 the intermediate member 10 is shown wrapped aroundthe soft tissue 16 with the first and second segments 18, 20 placed onopposite sides of the soft tissue 16 and secured to the soft tissue 16using preformed adjustable self-locking suture constructs 69 arranged ina u-shaped configuration. Each of the suture constructs 69 includesflexible anchors 70, 72 positioned on the same side of the soft tissue16 and held together using a tensioning member 74. Each of thetensioning members 74 includes a suture 75 arranged in a double-loopconfiguration with adjustable loops 76, 77 and ends 78. The tensioningmembers 74 may incorporate Ziploop™ Technology, available from Biomet ofWarsaw, Ind.

Each of the suture constructs 69 may be preformed by passing the ends 78of the suture 75 through passages in the flexible anchors 70, 72 in amanner similar to that described above with respect to the sutureconstructs 58. One of the flexible anchors 70, 72 may then be pushedthrough the soft tissue 16 in one direction and then pushed through thesoft tissue 16 again in the opposite direction to position the flexibleanchors 70, 72 on the same side of the soft tissue 16. The ends 78 ofthe suture 75 may then be pulled to decrease the size of the adjustableloops 76, 77 and thereby bring the first and second segments 18, 20 ofthe intermediate member 10 closer to each other. The ends 78 of thesuture 75 may then be tied together as shown or left as separatestrands.

Referring to FIGS. 7A and 7B, an intermediate member 80 is shown wrappedaround the soft tissue 16 to form spaced apart segments 80 a, 80 b withthe soft tissue 16 disposed between the segments 80 a, 80 b and sutureconstructs 82 extending through the segments 80 a, 80 b and the softtissue 16. Each of the suture constructs 82 includes a suture 84arranged in a double-loop configuration with two adjustable loops 86, 87and ends 88. The suture constructs 82 may incorporate Ziploop™Technology, available from Biomet of Warsaw, Ind. An exemplary sutureconstruct including two adjustable loops is disclosed in FIG. 4A of U.S.Pat. No. 7,601,165.

Each of the suture constructs 82 may be preformed in a manner similar tothat described above with respect to the suture construct 24. Theadjustable loops 86, 87 may then be pushed partially through theintermediate member 80 and the soft tissue 16 to position portions ofthe adjustable loops 86, 87 on both opposite sides of the soft tissue 16as shown. The ends 88 of the suture 84 may then be pulled to decreasethe size of the adjustable loops 86, 87. The ends 88 may then be tiedtogether as shown or left as separate strands.

Locking members 90 may be inserted into the adjustable loops 86 toprevent the adjustable loops 86 from being pulled through theintermediate member 80 when the ends 88 are pulled. The locking members90 may have sufficient rigidity and size to prevent the adjustable loops86 from being pulled through the intermediate member 80 but flexibleenough to enable manipulation thereof. The locking members 90 may bestrips, rods, or sutures, may be made from polyester, polyethylene,and/or polyether ether ketone (PEEK), and may have a thickness ordiameter between 0.25 millimeters (mm) and 0.5 mm. Further examples ofsuture constructs and locking members are disclosed in U.S. PatentApplication Publication No. 2011/0208240 (see, e.g., FIGS. 4 through 6),filed on May 2, 2011, which is incorporated by reference herein in itsentirety.

Referring to FIG. 8, an intermediate member 100 defines a plurality ofbifurcations or openings 102. The intermediate member 100 may be a flat,planar ribbon or sheath having a width that is greater than itsthickness. The intermediate member 100 may be formed (e.g., braided)from polyester, polyethylene, polyurethane urea, and/or bioresorbablematerial. Each end of the intermediate member 100 has suture ends 104extending therefrom and converging at a connection 106 between thesuture ends 104 and a needle 108. The suture ends 104 may beincorporated as part of the intermediate member 100 or be separate andpassed through passages within the intermediate member 100. In oneexample, the intermediate member 100 can be formed by braiding portionsof a plurality of strands and the unbraided portions of the strands mayform the suture ends 104.

The intermediate member 100 is shown connected to the flexible anchor 12using a preformed adjustable self-locking suture construct 110 thatincludes a double-loop configuration with two adjustable loops 112, 113and ends 114. The suture construct 110 may be formed in the mannerdescribed above with respect to the suture construct 24. When theflexible anchor 12 is secured to bone, the ends 114 may be pulled todecrease the size of the adjustable loop 112 and thereby bring theintermediate member 100 closer to the flexible anchor 12. Furtherexamples of suture constructs including adjustable loops and needles aredisclosed in U.S. Patent Application Publication No. 2012/0046693 (see,e.g., FIG. 13), filed on Nov. 3, 2011, which is incorporated byreference herein in its entirety.

Referring to FIG. 9, the intermediate member 100 may be placed aroundthe soft tissue 16 to form spaced-apart segments 100 a, 100 b with thesoft tissue 16 disposed therebetween, and the needles 108 may beinserted into the soft tissue 16 to secure the intermediate member 100to the soft tissue 16. Sutures 116, 118 may then be passed through theopenings 102 as the sutures 116, 118 are stitched in and out of the softtissue 16. The sutures 116. 118 are stitched in and out of the softtissue 16 towards a distal end 120 of the soft tissue 16 on one side ofthe soft tissue 16 and then stitched back in the opposite proximaldirection on the opposite side of the soft tissue 16. The ends of thesuture 116 may then be tied to the ends of the suture 118 as shown andthe needles 108 may be cut.

Instead of placing the intermediate member 100 around the soft tissue 16as shown, both ends of the intermediate member 100 may be placed on oneside of the soft tissue 16 in a manner similar to that shown in FIGS. 1through 3. In addition, various stitching methods other than that shownin FIG. 9 can be utilized to secure the intermediate member 100 to thesoft tissue 16. In any of these variations, the intermediate member 100transfers load from near the end 120 of the soft tissue 16 to furtheraway from the flexible anchor 12 and the intermediate member 100reinforces the suture/tendon interfaces.

Referring to FIG. 10, an intermediate member 130 may be a thin, flat,planar ribbon or braid having a width that is greater than itsthickness. The intermediate member 130 may be similar to theintermediate member 10 of FIG. 1. However, the intermediate member 10 ofFIG. 1 may be sized to cover a larger surface area on the soft tissue16, such as between 50 and 60 percent of the soft tissue surface area,to better distribute the load to the stitches 14. In contrast, theintermediate member 130 may be sized to cover a smaller surface area onthe soft tissue 16, such as about 10 percent of the soft tissue surfacearea, to maximize the direct contact between the soft tissue 16 and boneand thereby promote integration.

In various implementations, an orthopedic matrix or mesh 132 may bewrapped around the soft tissue 16 and the intermediate member 130 may beplaced over the mesh 132 on opposite sides of the soft tissue 16.Stitches 134 may be inserted through the intermediate member 130,through the mesh 132, and into the soft tissue 16 to secure theintermediate member 130 to the soft tissue 16. The stitching patternsdisclosed above can be incorporated in any of the embodiments disclosedherein. Thus, for example, the stitches 14 shown in FIGS. 1 through 3and/or the stitches 134 shown in FIG. 10 can incorporate one or more ofthe stitching patterns described with reference to FIGS. 4 through 6.

The mesh 132 may be a SportMesh™ Soft Tissue Reinforcement, availablefrom Arthrotek®, a Biomet® company of Warsaw, Ind. The mesh 132 mayimprove the distribution of load on the stitches 134 without increasingthe amount of surface area on the soft tissue 16 that is completelycovered. Further examples of orthopedic meshes are disclosed in U.S.Patent Application No. 2009/0318961 (see, e.g., FIGS. 36A, 36B, and360), filed on Jun. 22, 2009, which is incorporated by reference hereinin its entirety.

The intermediate member 130 is shown connected to the flexible anchor 12using a preformed adjustable self-locking suture construct 136 thatincludes a double-loop configuration with adjustable loops 138, 139 andends 140. The adjustable loop 138 may be formed in the manner describedabove with respect to the suture construct 24. When the flexible anchor12 is secured to bone, the ends 140 may be pulled to decrease the sizeof the adjustable loop 112 and thereby bring the intermediate member 100closer to the flexible anchor 12. The intermediate member 130 may thenbe inserted partially through the adjustable loop 138 and secured to thesoft tissue 16, and the ends 140 may be pulled to bring the soft tissue16 closer to the flexible anchor 12.

Referring to FIGS. 11 and 12, a two-piece suture construct 150 is shownconnected to the flexible anchor 12. The suture construct 150 includes apair of separate sutures 152 a, 152 b having ends 154 a. 154 b andbraided bodies 156 a, 156 b that form an intermediate member. Each ofthe braided bodies 156 a, 156 b includes a first portion 158 thatdefines a passage 160, a second portion 162, and a third portion 164.The first portion 158 may be a generally cylindrical braid, the thirdportion 164 may be a relatively flat braid such as a braided ribbon, andthe second portion 162 may be a transition braid from the cylindricalbraid to a flat braid. The first portion 158 may be wider than thesecond portion 162 and narrower than the third portion 164.

To form the suture construct 150, the suture 152 a may be passed throughthe passage 160 in the braided body 156 b, and the suture 152 b may bepassed through the passage 160 in the braided body 156 a. The sutureconstruct 150 may then be passed through the passage 44 in the flexibleanchor 12 to position the braided bodies 156 a. 156 b on opposite sidesof the passage 44 as shown. A suture 166 may then be stitched throughthe braided bodies 156 a, 156 b and the soft tissue 16 as shown in FIG.12 to secure the suture construct 150 to the soft tissue 16. The suture166 may be stitched using the crisscross pattern shown in FIG. 12 orother stitching techniques. Further examples of two-piece sutureconstructs are disclosed in U.S. Patent Application Publication No.2012/0053630 (see, e.g., FIG. 2), filed on Nov. 3, 2011, which isincorporated by reference herein in its entirety.

Referring to FIGS. 13A and 13B, the flexible anchor 12, the sutureconstruct 150, and the soft tissue 16 may then be inserted into a hole168 drilled through cancellous bone 170 and cortical bone 172. The hole168 may be a through bore that extends completely through the cancellousbone 170 and the cortical bone 172 as shown. Alternatively, the hole 168may be a blind bore that extends only partially through the cancellousbone 170 and/or the cortical bone 172.

If the hole 168 is a through bore, the flexible anchor 12 may be pushedall of the way through the hole 168 and tension may be applied to theends 154 of the suture 152 to set the flexible anchor 12 against thecortical bone 172. If the hole 168 is a blind bore, the flexible anchor12 may be pushed into the hole 168 and tension may be applied to theends 154 of the suture 152 to set the flexible anchor 12 against thecancellous bone 170 and/or the cortical bone 172. Once the flexibleanchor 12 is set, applying tension to the ends 154 pulls the soft tissue16 further into the hole 168. Although FIGS. 13A and 13B illustratingattaching soft tissue to bone using the suture construct 150, otherembodiments of suture constructs and intermediate members disclosedherein may be used in a similar manner to attach soft tissue to bone.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

1. (canceled)
 2. An apparatus for repairing a tear in soft tissue,comprising: a flexible bone anchor defining passage that extends throughthe flexible bone anchor; a suture construct including a first suturethat extends through the passage in the flexible bone anchor; anintermediate member configured to be coupled to the first suture; asecond suture configured to be passed through the intermediate memberand the soft tissue to form stitches that secure the intermediate memberto the soft tissue, wherein the intermediate member is configured toincrease pull-out forces of the stitches and transfer load from those ofthe stitches disposed closest to the bone anchor to those of thestitches disposed further away from the bone anchor.
 3. The apparatus ofclaim 2, further comprising: a third suture that extends through thepassage in the flexible bone an or an configured to be coupled to theintermediate member.
 4. The apparatus of claim 3, wherein: the firstsuture comprises a first body; the third suture comprises a second body;and the intermediate member includes the first and second bodies.
 5. Theapparatus of claim 4, wherein the first body and the second bodycomprise braided bodies.
 6. The apparatus of claim 4, wherein: atensioning end of the first suture is configured to be passed through apassage of the second body; a tensioning end of the third suture isconfigured to be passed through a passage of the first body; and theflexible bone anchor is configured to collapse responsive to tensionapplied to the tensioning ends of the first and third sutures.
 7. Theapparatus of claim 6, wherein: the first body includes a first portionthat defines the passage of the first body and a second portion thatextends from the first portion to the tensioning end, and the secondbody includes a third portion that defines the passage of the secondbody and a fourth portion that extends from the third portion to thetensioning end.
 8. The apparatus of claim 7, wherein: the first portioncomprises a cylindrical shape, and the second portion comprises a flatshape.
 9. The apparatus of claim 2, wherein the first suture forms anadjustable loop.
 10. The apparatus of claim 9, wherein the intermediatemember is configured to be inserted partially through the adjustableloop and folded to form first and second segments that are placeable onthe soft tissue.
 11. The apparatus of claim 2, further comprising: aneedle; and a third suture extending from the intermediate member andconnecting the needle to the intermediate member.
 12. The apparatus ofclaim 2, wherein the intermediate member defines preformed openings forreceiving the second suture as the second suture is passed in and out ofthe soft tissue to stitch the intermediate member to the soft tissue 13.The apparatus of claim 2, wherein the suture construct is configured tocause the flexible bone anchor to collapse responsive to tension appliedto the suture construct.
 14. An apparatus for repairing a tear in softtissue, comprising: a bone anchor defining a passage that extendsthrough the bone anchor; a suture construct including a first suturethat extends through the passage in the bone anchor to form anadjustable loop; an intermediate member configured to be insertedpartially through the adjustable loop and folded to form first andsecond segments that are placeable on the soft tissue; a second suturethat is configured to be passed through the first and second segments ofthe intermediate member and the soft tissue to form stitches that securethe intermediate member to the soft tissue, wherein the intermediatemember is configured to increase pull-out forces of the stitches andtransfer load from those of the stitches disposed closest to the boneanchor to those of the stitches disposed further away from the boneanchor.
 15. The apparatus of claim 14, wherein the intermediate memberdefines preformed openings for receiving the second suture as the secondsuture is passed in and out of the soft tissue to stitch theintermediate member to the soft tissue.
 16. The apparatus of claim 14,further comprising: one or more needles; and third and fourth sutures,the third and fourth sutures extending from opposite ends of theintermediate member and connecting the one or more needles to theintermediate member.
 17. An apparatus for repairing a tear in softtissue, comprising: a bone anchor defining a first passage; and a sutureconstruct including a first suture including a first braided body and asecond suture including a second braided body, wherein: the secondsuture extends through a second passage in the first braided body, thefirst suture extends through a third passage in the second braided body,the first and second sutures extend through the first passage in thebone anchor such that the first and second braided bodies are disposedon opposite sides of the first passage.
 18. The apparatus of claim 17,wherein: the first braided body includes a first portion that definesthe second passage and a second portion that extends from the firstportion in a direction away from the bone anchor, and the second braidedbody includes a third portion that defines the third passage and afourth portion that extends from the third portion in a direction awayfrom the bone anchor.
 19. The apparatus of claims 18, wherein: the firstportion comprises a cylindrical shape, and the second portion comprisesa flat shape.
 20. The apparatus of claim 17, wherein the bone anchor isa flexible anchor.
 21. The apparatus of claim 17, further comprising: athird suture configured to be passed through the suture construct andthe soft tissue to form stitches that secure the suture construct to thesoft tissue, wherein the suture construct is configured to increasepull-out forces of the stitches and transfer load from those of thestitches disposed closest to the bone anchor to those of the stitchesdisposed further away from the bone anchor.